OBJECTIVES: To quantify the 1-year economic burden from a US payer perspective among patients with CAP initially diagnosed and treated in the outpatient setting.

METHODS: Adult patients with an initial outpatient diagnosis of CAP between 1/2012-12/2016 were identified via administrative coding from the IQVIA Real-World Data Adjudicated US Claims database. To be included, patients had to receive empiric antimicrobial treatment as combination (EC) or monotherapy (EM), have a chest x-ray on the index date or 1 day after, and be continuously enrolled in the health plan ≥180 days prior to and ≥360 days following the index date. Unadjusted healthcare resource utilization and costs were assessed over a 1-year follow-up from the index date.

RESULTS: A total of 256,916 patients (mean age: 45.7; 52.0% female, 58.7% commercially-insured) with CAP were included. The majority (75.8%) initiated EM, most frequently with fluoroquinolones (31.2%) or macrolides (28.1%). During the 1-year follow-up, the mean total cost per patient was $14,372, one-tenth (10.9%, $1,561) of which was CAP-related. Outpatient care accounted for over one-half of total costs (55.4%, $7,967), followed by inpatient care (26.1%, $3,746) and outpatient pharmacy (18.5%, $2,659). Among the total cohort, 113,166 (44.0%) had ≥1 ER visit. Patients had a mean of 11.2 physician office visits, 25.8 outpatient prescription fills, and 14.6 lab/pathology tests. 10.6% (n=27,209) of the cohort had ≥1 hospitalization, and of these, 18.7% were CAP-related. The first CAP-related hospitalization was associated with a mean inpatient cost of $18,649 and mean length of stay of 5.8 days.

CONCLUSIONS: The 1-year unadjusted economic burden among CAP patients initially managed in the outpatient setting is substantial. Among patients who required hospitalization, inpatient care was costly. Though rare, CAP-related hospitalizations added considerably to the costs.